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Wiki 90460/90461

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T

TLC

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According to the CPT book 90460/90461 are suppose to be "broken down" as per component of the shot, EG: If a patient got a MMR-(IM admin) and a Dtap-IPV(SQ admin) it would be as MMR, 90460,90461x2,,and the Dtap-IPV 90460,90461x4,,is this really correct billing?? and will the insurance company really pay on these this way, I understand the doctor's have to have good documentation stating they explained each component of "EACH" shot given and or given pamphlets on each shot? Thanks, Terry
 
Terry,

I will wager an opinion here.

Per the CPT guidelines, 90460 is reported for each vaccine administered. If you administer a combination vaccine with multiple components, 90460 is reported for the first component and 90461 is reported for each additional component. These codes are only used when counseling is provided by the physician or "other qualified health care professional" prior to the vaccine administration.

The examples you have provided above are coded correctly. I would recommend you consult with your payers because some payers may not accept billing in units and may want the vaccines reported as separate line items.

As for reimbursement, this will obviously depend on the specific payer but I am not aware of any denials at my clinics with these codes.

Hope this helps and again this is my opinion.
 
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